Mpox
This article is more than 2 years old
Why are monkeypox cases suddenly
emerging across the world and could the
virus have mutated?
Data prior to current outbreaks suggested resurgence of the
disease, with waning immunity from smallpox vaccination
contributing to spread
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Monkeypox, which was first identified in 1970, usually only occurs outside central and western African when
an infected traveller returns home.
Photograph: Dado Ruvić/Reuters
Melissa Davey Medical editor
Mon 23 May 2022 19.30 CEST
The sudden emergence of monkeypox in several countries has raised
questions about how the virus, which is most common in central and west
Africa, has managed to spread.
Many health experts have said the monkeypox cases in 12 countries are not
cause for panic, given the virus is much less infectious than illnesses like
Covid and rarely fatal, but it is highly unusual.
First identified in 1970, monkeypox cases usually only
occur outside central and west Africa when a traveller becomes infected
there and subsequently returns home. These cases do not usually lead to
wider outbreaks.
In other rare cases, owners of imported pets become infected, with animals
such as rodents believed to be sources of transmission.
But the World Health Organization [WHO] said cases are rising in non-
endemic countries, with no link to travel or animals identified in most of
these cases.
So what are the main theories about why cases are suddenly emerging this
time?
Protection from smallpox vaccines is waning
Prof. Raina MacIntyre, who heads the biosecurity program at the Kirby
Institute, told the Medical Journal of Australia that “waning of immunity
from smallpox vaccination may be contributing to the increasing outbreaks
of monkeypox”.
“It is more than 40-50 years since mass vaccination ceased,” she said.
The smallpox vaccine offered the bonus of strong protection against
monkeypox. A study published in the journal PLOS Neglected Tropical
Diseases in February which warned monkeypox cases were rising also
attributed this to the cessation of widespread smallpox vaccination, given
that virus has been declared by WHO as eradicated.
In some countries where the virus has been detected, like Australia, mass
smallpox vaccination never occurred.
Cases have actually been rising for a while
Epidemiologists flagged growing case numbers before WHO issued its alert
earlier in May. There were calls for better worldwide surveillance and
detection of monkeypox cases prior to the current outbreaks because of data
suggesting a resurgence of the disease.
Between 2010 and 2019, cases re-emerged in Liberia and Sierra Leone after a
four-decade absence and in Central African Republic after three decades,
research published in February and led by Pallas Health Research and
Consultancy in The Netherlands found.
Since the Covid-19 pandemic began researchers and health workers
worldwide are also more alert to symptoms of viruses and are quicker to
report anything unusual, helping to lead to the detection of cases.
Could the virus have mutated?
Human-to-human spread is not easy for monkeypox; one study found 3% of
close contacts of someone with monkeypox will become infected.
But the strange rise in cases has raised the possibility that the virus may
have mutated in a way that makes person-to-person transmission more
likely.
More data and laboratory analysis is needed to confirm this, however, and
for now it is just a theory. Sequencing of the virus in laboratories is
occurring, and we should know within days whether the virus has changed.
While monkeypox has been around for decades it is nonetheless considered
a rare disease, meaning there is always more to learn about it.
The virus may just have taken advantage of an
ideal situation
When monkeypox does spread between humans, it is through close physical
contact with someone who has symptoms. Monkeypox can lead to pus-filled
lesions developing on the skin, and contact with fluid from this rash –
including contact from contaminated clothing and bedding – can spread the
virus.
Sores in the mouth can also be infectious.
In the current outbreak, clusters have occurred among
men who have sex with men, which has not been the case previously. But
experts have warned against declaring it a sexually transmitted disease, or
attributing spread to certain communities. It is much more likely that the
close contact that occurs during sex is responsible for spread, rather than the
disease being sexually transmitted.
In the meantime WHO has urged people not to stigmatise those diagnosed
with the virus.
“We have seen messages stigmatising certain groups of people around this
outbreak of monkeypox,” WHO said in a statement.
“We want to make it very clear that this is not right. First of all, anyone who
has close physical contact of any kind with someone who has monkeypox is
at risk, regardless of who they are, what they do, who they choose to have
sex with or any other factor.”
It could be that the virus has not mutated at all, but that it has taken
advantage of an ideal opportunity to spread when all the conditions were
right; for example, in a community of people in close contact with each
other, where there were multiple opportunities for spread.
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